Strep throat is caused by the bacterium Streptococcus pyogenes, also known as Group A Streptococcus (GAS). While antibiotic treatment usually clears the infection quickly, seeing the illness return soon after can cause worry and confusion. Recurrence is a manageable issue, and understanding the reasons behind it is the first step toward finding a lasting solution for your child.
Understanding the Difference Between Relapse and Reinfection
Addressing repeated strep episodes requires determining if the infection is a relapse or a true reinfection. A true relapse occurs when the original infection was not completely eliminated, most often happens if the full course of prescribed antibiotics is not completed. Even if a child feels better and symptoms disappear within a day or two, stopping the medication early leaves a small number of bacteria to multiply, causing the infection to flare up again shortly after treatment ends.
This incomplete elimination of bacteria allows the surviving organisms to potentially develop a tolerance, making the next round of antibiotics less effective. Completing the entire prescription ensures all GAS bacteria are killed, preventing relapse.
A true reinfection means the child was successfully cleared of the initial bacteria but was then exposed to a new source of the infection. This is common in environments where strep is actively circulating, such as schools, daycares, or within the home. The recurring strep episodes are distinct, new infections, not a failure of the initial antibiotic treatment.
In cases of frequent return, doctors may perform a follow-up throat swab after the antibiotic course is finished, known as a “test of cure,” to confirm the bacteria are gone, although this is not routine practice. This testing helps differentiate a treatment failure from subsequent re-exposure. Identifying whether the issue is a failure to clear the bacteria or a repeated exposure to a new strain guides the next steps in management.
Identifying Asymptomatic Carriers in the Household
A frequent cause of continuous reinfection is the presence of an asymptomatic carrier within the household. An asymptomatic carrier harbors Group A Streptococcus bacteria in their throat but shows no symptoms. Up to 25% of school-aged children and a smaller percentage of adults may be strep carriers, capable of passing the bacteria to others.
These carriers serve as a reservoir, continuously shedding the bacteria into the shared environment and reinfecting the symptomatic child shortly after their antibiotic course is finished. The carrier state itself is generally harmless to the individual, but it can be the source of a “ping-pong” effect, passing the infection back and forth between family members.
If your child is experiencing repeated strep episodes despite completing their antibiotics, testing other close contacts, such as siblings or parents, can identify the hidden source. While routine screening is not recommended, a doctor may suggest testing household members if the child has experienced multiple, documented infections. If a carrier is identified, a specific antibiotic regimen may be prescribed to attempt to eradicate the bacteria and break the cycle of infection.
Beyond testing, managing the shared environment is a practical step to reduce the risk of reinfection. GAS bacteria can survive on surfaces for days, making personal items potential sources of re-exposure. Replacing your child’s toothbrush immediately after they start antibiotics and again once they are completely well is a simple, proactive hygiene measure.
Regularly cleaning shared items like phones, remote controls, and toys can also minimize the environmental presence of the bacteria. Promoting diligent hand-washing for all family members is an effective barrier to transmission, especially for children who are frequently in close contact. These hygiene steps, combined with carrier identification, can significantly reduce the likelihood of the strep recurring.
When Recurrence Warrants Tonsillectomy
For a small number of children, recurrent strep infections persist despite addressing antibiotic compliance and household carriage. Medical professionals may then consider a tonsillectomy (surgical removal of the tonsils). This procedure is generally reserved for children whose infection frequency significantly impacts their health and quality of life.
To provide an objective standard, doctors often use established guidelines, such as the Paradise Criteria, to determine if surgery is appropriate. These criteria outline specific frequency thresholds for documented throat infections. A child meets these criteria if they have had at least seven documented strep episodes in the past year, or at least five episodes per year for two consecutive years, or at least three episodes per year for three consecutive years.
Each of these episodes must be properly documented in the medical record and accompanied by clinical features like a fever above 101°F (38.3°C), swollen neck lymph nodes, or pus on the tonsils. Before recommending surgery, an Ear, Nose, and Throat (ENT) specialist will review this documentation to confirm the frequency and severity meet the guidelines.
The goal of the tonsillectomy is to remove the tonsillar tissue, which can sometimes harbor the bacteria, making it difficult for antibiotics to fully penetrate and eliminate the infection. Parents should have an open discussion with their ENT specialist about the potential benefits, which include a modest reduction in the frequency of future throat infections.